HLTHAGE 3R03: INTRODUCTION TO HEALTH INEQUALITIES Winter 2017

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1 HLTHAGE 3R03: INTRODUCTION TO HEALTH INEQUALITIES Winter 2017 Instructor: Lydia Kapiriri Class Meets: Mon Thursdays pm Office: KTH 236; ext Office hours: By appointment. Course Description Despite today s level of economic development and advancement in technology, enormous inequalities in health persist both within and between countries. This course will introduce students to the key concepts, and theories that explain the patterns in health inequalities. Using common examples of the intersections in health inequalities such as gender, ethnicity or race, we will critically analyze mechanisms through which health inequalities arise, are sustained and can be addressed within societies. Course Objectives By the end of the course participants should be able to: Describe and critique the models and aetiological pathways by which health inequities arise and are sustained in societies Describe the determinants of health inequalities Critically analyse and evaluate current policies and approaches to reducing the existing disparities in health COURSE STRUCTURE The learning modes will include in-class and out of class components. The in-class component of the course will predominantly comprise of lectures and group discussion. Required Text 1) Text Book: Bartley M. Health Inequality: An introduction to Theories, Concepts and Methods Polity Press, Cambridge. 2) Additional readings in courseware, and online Assessments The course will have the following components used for assessment: Class Participation 15% Written Assignment I 20% Test 30% Term Paper 35% See Details in Appendix i. 1

2 DATE TOPIC READINGS Week 1: Jan 5 th Course overview No Readings assigned Individual assignment: Think about a health problem which is unequally distributed within society Week 2: Jan 9 th, 12 th Health inequalities: Definitions, concepts and theories Text Book: Chapter 1 1. Arcaya MC., Arcaya AL.and Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action 2015, 8: Individual assignment: Think about possible ways to explain the unequal distribution of the health problem within society. Overview of the models of Etiological Pathways Week 3: Jan 16 th, 19 th Behavioral and cultural explanations Text Book: Chapter 4 1. Geyen, Dashiel J. Ed.D., M.P.H. (2012) "Behavioral Changes for African Americans To Improve Health, Embrace Culture, and Minimize Disparities," ECI Interdisciplinary Journal for Legal and Social Policy: Vol. 2: Iss. 1, Article 2. Available at: 2. Abel, T. & Frohlich, B.K.(2012). Capitals and capabilities: Linking structure and agency to reduce health inequalities. Social Science & Medicine,74(2), Individual assignment: How can the behavioral and cultural pathway be used to explain the identified health inequality? Week 4: Jan 23 rd, 26 th The Psycho- social model Text Book: Chapter 5 1. Elstad J. (1998). The Psycho-social Perspective on Social Inequalities in Health. Sociology of Health & Illness, 20 (5): Individual assignment: How can the psycho- social pathway be used to explain the identified health inequality? 2

3 Week 5: Jan 30 th, Feb 2nd The materialist model Text Book: Chapter 6 1. Blane, D.B., Bartley, M. & Davey Smith, G. (1997). Disease etiology and materialist explanations of socio-economic mortality differentials. European Journal of Public Health, 7, Rajan, K., Kennedy, J., & King, L.(2013). Is wealthier always healthier in poor countries? The health implications of income, inequality, poverty, and literacy in India. Social Science & Medicine, 88: Individual assignment: How can the materialistic pathway be used to explain the identified health inequality? Week 6: Feb 6 th, Feb 9 th Week 7: Feb 13 th, Feb 16 th Life- course Approach Review and Written Assignment Text Book: Chapter 7 1. Hatch, SL Conceptualizing and Identifying Cumulative Adversity and Protective Resources: Implications for Understanding Health Inequalities. J Gerontol B Psychol Sci Soc Sci 60 (Special Issue 2): S130-S134 Individual assignment: How can the life-course pathway be used to explain the identified health inequality? All readings covered to date. Feb 20 th - 25 th : No Classes Health Inequalities: Understanding the intersections Week 8: Feb 27 th, March 2 nd Social Ecology Text Book: Chapter 8 1. Pearce, J., Barnett, R. & Moon. G.(2012). Sociospatial inequalities in health- related behaviours: Pathways linking place and smoking. Progress in Human Geography, 36(1), 3-24 Assignment 1 due in class 3

4 Individual assignment: In what ways does social ecology explain the identified health inequality? Week 9: March 6 th, March 9 th Gender and Health Inequalities Text Book: Chapter 9 1. Richardson, E.T., Collins, S.E., Kung, T., Jones, J.H., Tram, K.H., Boggiano, V.L., Zolopa, A.R. (2014). Gender in equality and HIV transmission: A global analysis. Journal of the International AIDS Society, 17(1),1-5. Retrieved from 21) 2. Griffith, D.M., Metzl, J.M. & Gunter, K. (2011). Considering intersections of race and gender in interventions that address US men s health disparities. Public Health, 125(7), Individual assignment: How does the health issue you have chosen vary across different genders? Week 10: March 13 th, March 16 th Race, Ethnicity and Health inequalities Text Book: Chapter Gee, G.C., Waslemann, K.M. & Brondolo, E. (2012). A life course perspective on how racism may be related to health inequities. American Journal of Public Health, 102(5), Sawyer, P.J., Major, P., Casad, B.J., Townsend, S.S. & Mendes, W.B. (2012). Discrimination and the stress response: Psychological and physiological consequences of anticipating prejudice in interethnic interactions. American Journal of Public Health, 102(5), Individual assignment: How does the health issue you have chosen vary across races and ethnicities? 4

5 Week 11:March 20 th, March 23 rd Review and Test In Class Test Tackling health inequalities Week 12: March 27 th, March 30 th Health inequalities: Implications for Social Policy and Individual Innovations for tackling health inequalities Text Book: Chapter Woodward & Kawachi. Why reduce health inequalities? J Epidemiol Community Health 2000; 54: Marmot, M. & Bell, R. (2012). Fair society, healthy lives. [Supplement 1].Public Health, 126, S4-S Whitehead & Dahlgren; Ten principles for policy action: Levelling up Part 1, 2006 WHO collaborating centre for social determinants of health. Studies on social and economic determinants of population health, No. 2 (Online). Pgs 16-23, Week 13:April 3 rd, April 6 th Review of the final paper Individual assignment: Why do you think it would be critical for the health inequality you have chosen to be addressed? What strategies have been used to address the health inequality you have selected? How would you address the health inequality? No readings assigned Week 14: April 10 th : Final Paper due by 4.00pm. 5

6 Appendix i: Assessment 1) Class participation (15%) After the first class, each student will be expected to identify a health problem which is unequally distributed in society which they will work with. Based on the week s readings, students will develop and submit ½ -1pg summary of the individual allocated assignment for the week. These will be evaluated for the quality of the content and actual submission. A perfect mark (15/15) is possible if the student submits ALL the required summaries with the relevant content. Each student is expected to submit any 8/10 participation assignments to get the full participation mark. All summaries will be submitted in class; students have to be in class to submit their work. You should also come prepared to share the content in your summary when requested to. These summaries will be critical in developing your major written assignments; so it is highly recommended that students complete them. 2) Written assignment 1: A critical Review of the models of etiological pathways (20%) Based on the provided resources and 4 additional independent scholarly references, students will critically analyze any 2 of the etiological pathways in relationship to the health inequality of their choice. In this short paper, students will i) Provide a brief overview of the paper ii) Describe a health inequality of their choice and explain how it varies within society iii) Identify any 2 of the etiological pathways that they think are best suited to explain the health inequality they are focusing on. iv) Use the 2 pathways to explain the selected health inequality v) Reflect on the strengths and weaknesses of using each pathway to explain the chosen health inequality vi) Conclusions based on the above discussion This should be summarized in 6 double spaced Pgs. And use at least 4 peer reviewed sources. (for formatting details refer to appendix ii) Submit a soft copy on avenue and a hard copy in class. 3) Test 30%. The test will comprise of material covered in class until the date of the test. The material that you should have read will be discussed in class before the test. The test will comprise of multiple choice and short answer questions. 4) Term paper (35%) The final paper will provide students with an opportunity to demonstrate their learning by applying the theories of health inequalities to evaluate a program addressing a health 6

7 inequality of their choice. Students will identify a health program (in real life or via the internet) that they think addresses a health problem that is unequally distributed in society (It is advisable (but not mandatory) that you work with the inequality you have been focusing on during the term). While creative writing is encouraged; the final paper should at least have the following sections: 1) A title page 2) Overview Identify the research topic you are going to address, and provide a brief back ground/context of this topic; Identify the main purposes/ objectives of this research essay; Identify the significance of your discussion for health 3) The body of the essay (i.e., your analysis of the research topic) Identify and elaborate on the main issues concerning your research topic; Provide a detailed description of the health inequality, and one of the interventions that the program is using to address the health inequality Based on the above intervention, discuss one of the etiological framework (s) that may have guided the program in their choice of interventions. Critically analyse the implications of using above framework in designing the interventions (include both the strengths and limitations) for the particular population they are focusing on. Based on the research you have conducted and what you have learnt from the class discussions, would you support the approach used in the above program? If so (or if not), give reasons for your response. 4) Conclusions Develop your main conclusions based on the discussion. Indicate the implications of your research for social policy. 5) Limitations and future research areas Point out the constraints or limitations of your discussion, Provide critical reflections on the various sources of information that you used to engage in the discussion. Identify 2 key gaps you have identified in the literature that merit further examination. Requirements: A maximum of 12 double spaced pgs. At least 6 scholarly references (for formatting details, refer to appendix ii) Submit a soft copy on avenue and a hard copy in KTH 226 by 4.00pm on April 10th. 7

8 Appendix ii LATE PENALTY POLICY DEADLINES ARE FIRM. Assignments are to be submitted in class on, or before, the due date indicated. All assignments must be completed in order to pass the course. Late assignments should be submitted to Danielle Schumacher (KTH/226) where they will be date/time stamped. Papers submitted after the due date will be assessed a 5% per day penalty. Weekends will be treated as one day late. Please note that no extensions will be permitted for reasons other than a documented illness. If you are unable to hand-in a paper because of illness, please consult with the Dean s Office. RETENTION OF WORK I require that students keep ALL of their rough work for their essays and be able to produce this material on 24 hours notice. In some cases, I will ask for this material to be submitted with your assignments. This includes rough notes, early drafts, etc. This is partly a protection for you. If there is any doubt over the grade assigned on a project, or if you would like to appeal a grade or if you happen to be charged with plagiarism, this work can provide a basis for settling the issue. Without it, you may not be given the benefit of the doubt. With it, the issue is easily resolved. You should keep this material until you have been notified of your grade. If you are using a word-processor, keep both your rough notes and early drafts. CITATIONS I expect you to cite and properly reference any and all material taken from a secondary source for ALL YOUR WRITTEN ASSIGNMENTS. You must acknowledge every idea, fact, or mode or analysis taken from another source and not just direct quotes. This includes ALL material that you use in your papers other than that based on your own ideas and analyses. This includes required course readings and paraphrases taken from a source. It is perfectly respectable to take an idea from another source and then develop that idea in your own way, or to use someone's method or structure and apply it to a new case so long as you indicate clearly what was derived from the original source and what is your own. You are required to use the citation and referencing guidelines from the American Psychological Association. These guidelines are contained in the publication, Publication Manual of the American Psychological Association (the references in the course guide roughly follow APA format). Papers with poor referencing and acknowledgement of original sources will be marked down severely. Not acknowledging sources that you have used or acknowledging them only part of the time borders on plagiarism and may be treated as such. If in doubt, acknowledge the source. ACADEMIC DISHONESTY You are expected to exhibit honesty and use ethical behavior in all aspects of the learning process. Academic credentials you earn are rooted in principles of honesty and academic integrity. Academic dishonesty is to knowingly act or fail to act in a way that results or could result in unearned academic credit or advantage. This behavior can result in serious consequences, e.g. the grade of zero on an assignment, loss of credit with a notation on the transcript (notation reads: Grade of F assigned for academic dishonesty ), and/or suspension or expulsion from the university. It is your responsibility to understand what constitutes academic dishonesty. For 8

9 information on the various types of academic dishonesty please refer to the Academic Integrity Policy, located at The following illustrates only three forms of academic dishonesty: 1) Plagiarism, e.g. the submission of work that is not one s own or for which other credit has been obtained. 2) Improper collaboration in group work. 3) Copying or using unauthorized aids in tests and examinations. ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES Students who require academic accommodations must contact Student Accessibility Services (SAS) to make arrangements with a Program Coordinator. Academic accommodations must be arranged for each term of study. Student Accessibility Services can be contacted by phone at ext , or by at sas@mcmaster.ca. For further information, consult McMaster University's Policy for Academic Accommodation for Students with Disabilities: StudentsWithDisabilities.pdf FACULTY OF SOCIAL SCIENCES COMMUNICATION POLICY Effective September 1, 2010, it is the policy of the Faculty of Social Sciences that all communication sent from students to instructors (including TAs), and from students to staff, must originate from the student s own McMaster University account. This policy protects confidentiality and confirms the identity of the student. It is the student s responsibility to ensure that communication is sent to the university from a McMaster account. If an instructor becomes aware that a communication has come from an alternate address, the instructor may not reply at his or her discretion. If you require this information in an alternate/accessible format, please contact the Department of Health, Aging & Society at ext or hasdept@mcmaster.ca. The instructor and university reserve the right to modify elements of the course during the term. The university may change the dates and deadlines for any or all courses in extreme circumstances. If either type of modification becomes necessary, reasonable notice and communication with the students will be given with explanation and the opportunity to comment on changes. It is the responsibility of the student to check their McMaster and course websites weekly during the term and to note any changes. 9

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